Gastrointestinal: Reversal of superior mesenteric artery syndrome following pregnancy

Superior mesenteric artery (SMA) syndrome is obstructive compression of the third portion of the duodenum between the SMA and the aorta. We describe spontaneous reversal of SMA syndrome following pregnancy. A 38-year-old woman presented to the emergency department with mid-epigastric pain and intractable vomiting in the setting of recent intentional weight loss. Imaging revealed the presence of a massively dilated stomach and duodenal compression consistent with SMA syndrome (Fig. 1). Given symptom severity, surgery was offered; however, the patient declined when she became pregnant during her preoperative evaluation. Nutritional deficiencies subsequently developed increasing the risk for fetal compromise. Surgery and enteral feeding tubes were again offered; however, the patient declined and was later able to reach protein calorie goals with full oral liquid nutrition. Following delivery, all obstructive symptoms spontaneously resolved, and no evidence of compression was seen on repeat imaging (Fig. 2). This resolution persists after 18 months of follow-up. In pregnancy, nutritional deficiencies leading to inadequate fetal growth and development can increase the risk of pregnancy loss. Thus, interventions may be required to correct the obstruction prior to delivery. This case demonstrates spontaneous resolution of SMA syndrome following pregnancy. The physiologic changes occurring with pregnancy may lead to natural correction of the obstruction. Additionally, supportive care with sufficient oral liquid intake may be the goal of treatment in these particular cases rather than exploring surgical intervention.